The Little Hoover Commission, citing a decade of bureaucratic stumbles and data challenges, called Tuesday for the state to address critical shortcomings in its implementation of 2004’s Proposition 63, known as the Mental Health Services Act (MHSA). After 10 years the state still can’t document whether $13 billion raised through the act has improved the streets of California and the lives of its residents.

In a report to Governor Brown and the Legislature, the Commission cited anecdotal stories of significant successes and improvements in California’s mental health system, but found the state still cannot definitively quantify who has been helped by Proposition 63 spending and how. Nor can the state demonstrate meaningful big-picture outcomes – such as reduced homelessness or improved school attendance – more than a decade after voters hiked income taxes on the wealthiest Californians to expand care for the severely mentally ill and reorient programs and services toward prevention and early intervention.

In the report, Promises Still to Keep: A Decade of the Mental Health Services Act, the Commission called on the state to better validate how the money has been used to help Californians with mental illness recover and find stable housing or jobs – and how it has prevented others from developing a serious mental illness. The Commission urged the Governor, Legislature and state agencies responsible for overseeing the act to take several actions, including expanding the authority of the MHSA oversight commission and improving financial reporting to ensure progress toward outcomes that Proposition 63 supporters promised to voters in 2004.

“The Mental Health Services Act was a landmark initiative for California, bringing new and needed money to a neglected and underfunded system,” said Little Hoover Commission Chairman Pedro Nava. “But agencies implementing a measure that promised to make a demonstrable difference on the street, in jail populations and in peoples’ lives still can’t tell a conclusive story of how it’s succeeding or where it’s falling short. While there are numerous success stories, those programs that deliver effective services are not showcased for their success while unsuccessful programs may be allowed to operate without sunshine.”

The Commission’s report describes a 10-year history of good intentions sometimes confounded by bureaucratic missteps, a severe downturn in the economy and ever-changing oversight structure.

Weak oversight of expenditures, implementation. Despite several legislative interventions over the past decade, the Commission found an oversight system in need of prompt and dramatic review. The Commission heard that the state continues to lack a strong oversight body that is empowered to monitor and oversee county programs and swiftly correct problems – such as mishandled funds. The state offers few repercussions for counties that fail to provide required information about their implementation of the act, and consequently, state agencies cannot collect consistent data to conduct necessary evaluations.

Poor transparency, fiscal accountability. The Commission heard that the state urgently needs better data to understand the act’s successes and identify areas of need. One culprit is an aging and severely inadequate data system incapable of combining data or evaluative results across all components of the act. The Commission, likewise, heard that the state can do better to make information it collects available online – in a clear, understandable format – about how much revenue the act generates yearly and where and how it is spent in individual counties and statewide.

Commission recommendations:

The Legislature should expand the authority of the state’s Mental Health Services Oversight and Accountability Commission to conduct up-front reviews of sometimescontroversial Prevention and Early Intervention plans funded by the act before funds are budgeted. The oversight commission also should be empowered to impose sanctions and withhold county funding when it identifies deficiencies in a county’s spending plan. To provide greater accountability of the portion of MHSA funds that support state programs (more than $80 million in 2014), the oversight commission also should have a role in developing recommendations for and consulting with the Department of Finance before the funds are allocated.

The state oversight commission and the Department of Health Care Services should work together to develop a meaningful accountability data system for the Mental Health Services Act that provides reliable, timely information that allows it to monitor effective progress toward the act’s goals.

The MHSA oversight commission should improve and update its website to make it easier for voters, taxpayers and mental health advocates, consumers and their families to see how and where the money is spent and who benefits from its services.

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to improve the efficiency and effectiveness of state programs. The report and documents from the Commission’s September 2014 public hearing on this topic, including the agenda and written testimony submitted by witnesses, are available on the Commission’s website at www.lhc.ca.gov.

Fact Sheet

Study Description

For this study, the Commission reviewed oversight mechanisms for the Mental Health Services Act funds and the outcomes resulting from the state’s investment in mental health services. Proposition 63, known as the Mental Health Services Act (MHSA), was a ballot measure enacted by voters in November 2004 that created a 1 percent income tax on personal income in excess of $1 million.

The Commission last conducted a comprehensive review of the state’s capacity to deliver mental health services more than a decade ago. At the time, the Commission found the state rationed care only to those with the most extreme needs and, with a dearth of adequate services, essentially had criminalized mental illness. In its 2000 report, Being There: Making a Commitment to Mental Health, the Commission called for the state to build the public support and system capacity to proactively help people maintain their functionality through high quality, tailored mental health services.

With passage of Proposition 63, California voters approved an historic investment in the state’s mental health system – and made an annual commitment to investing in effective treatment and support, as well as providing oversight of fund expenditures to ensure accountability to taxpayers and the public. Since enacted, the MHSA has generated billions of dollars in dedicated funding for mental health services. The fund will draw in an estimated $1.58 billion in fiscal year 2014-15 alone.

Amendments to the MHSA in 2012 transferred responsibility for oversight and evaluation of county mental health programs from the Department of Mental Health to the Department of Health Care Services. Legislation also expanded the role of the Mental Health Services Oversight and Accountability Commission to provide training and technical assistance for county mental health planning and to evaluate MHSA-funded programs throughout the state. However, a 2013 review by the California State Auditor found the state provided little oversight of county implementation of MHSA programs and their effectiveness and that each of the four county departments reviewed used different and inconsistent approaches to assess and report on their MHSA programs.

As part of its study, the Commission explored whether the existing oversight mechanisms are adequate to ensure money generated through the MHSA is spent in the most cost-effective manner and services are provided in accordance with recommended best practices as the voters intended. The Commission also considered whether additional opportunities exist to improve oversight of these funds. Additionally, the Commission examined how the state is monitoring the outcomes of its investment to identify and replicate proven best practices where appropriate.

Agenda

Overview

In this report, the Commission calls for the state to address critical shortcomings in its implementation of 2004’s Proposition 63 ballot measure, known as the Mental Health Services Act.

During its review, the Commission found that the state can’t quantifiably validate how billions generated annually by Proposition 63 have been used to help Californians with mental illness recover and thrive, and how it has prevented others from developing a serious mental illness. The Commission also found weak oversight of expenditures and implementation, and poor transparency and fiscal accountability of funds.

The Commission recommends stronger oversight and better financial reporting to document its impact.

PUBLIC NOTICE

On Tuesday, September 23, 2014, the Little Hoover Commission will conduct a public hearing on Proposition 63, the Mental Health Services Act of 2004. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

At this hearing, the Commission will review oversight mechanisms for the Mental Health Services Act (MHSA) funding and the outcomes resulting from the state’s investment of this funding in mental health services.

The Commission will first hear from a co-author of the initiative who will provide his 2004 and current expectations for the initiative, explain how the Act has changed and consider the appropriateness of the current oversight structure. Next, a panel comprised of two organizations that represent clients and their families has been asked to discuss how mental health services have fared since passage of MHSA. The Commission will then hear from the director of research and evaluation of the Mental Health Services Oversight and Accountability Commission, who will discuss the commission’s evolving role and strategies to improve oversight of the MHSA funds. The director will be accompanied by two commissioners who respectively chair the commission’s financial oversight and evaluation committees. The Commission also will hear from the deputy director of the Department of Health Care Services’ mental health and substance use disorder services division, who will discuss the department’s new role in providing oversight of MHSA funds and the impact of the MHSA on statewide capacity to provide mental health services and supports. Finally, representatives from Los Angeles and Sonoma county behavioral health departments will discuss how the MHSA funds have been used in their counties and describe their efforts to measure, track and evaluate MHSA outcomes.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Conference Room 175 on the first floor of 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Tuesday, September 16, 2014.

PUBLIC NOTICE

On Tuesday, September 23, 2014, the Little Hoover Commission will conduct a public hearing on Proposition 63, the Mental Health Services Act of 2004. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

At this hearing, the Commission will review oversight mechanisms for the Mental Health Services Act (MHSA) funding and the outcomes resulting from the state’s investment of this funding in mental health services.

The Commission will first hear from a co-author of the initiative who will provide his 2004 and current expectations for the initiative, explain how the Act has changed and consider the appropriateness of the current oversight structure. Next, a panel comprised of two organizations that represent clients and their families has been asked to discuss how mental health services have fared since passage of MHSA. The Commission will then hear from the director of research and evaluation of the Mental Health Services Oversight and Accountability Commission, who will discuss the commission’s evolving role and strategies to improve oversight of the MHSA funds. The director will be accompanied by two commissioners who respectively chair the commission’s financial oversight and evaluation committees. The Commission also will hear from the deputy director of the Department of Health Care Services’ mental health and substance use disorder services division, who will discuss the department’s new role in providing oversight of MHSA funds and the impact of the MHSA on statewide capacity to provide mental health services and supports. Finally, representatives from Los Angeles and Sonoma county behavioral health departments will discuss how the MHSA funds have been used in their counties and describe their efforts to measure, track and evaluate MHSA outcomes.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Conference Room 175 on the first floor of 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Tuesday, September 16, 2014.

PUBLIC NOTICE

On Tuesday, September 23, 2014, the Little Hoover Commission will conduct a public hearing on Proposition 63, the Mental Health Services Act of 2004. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

At this hearing, the Commission will review oversight mechanisms for the Mental Health Services Act (MHSA) funding and the outcomes resulting from the state’s investment of this funding in mental health services.

The Commission will first hear from a co-author of the initiative who will provide his 2004 and current expectations for the initiative, explain how the Act has changed and consider the appropriateness of the current oversight structure. Next, a panel comprised of two organizations that represent clients and their families has been asked to discuss how mental health services have fared since passage of MHSA. The Commission will then hear from the director of research and evaluation of the Mental Health Services Oversight and Accountability Commission, who will discuss the commission’s evolving role and strategies to improve oversight of the MHSA funds. The director will be accompanied by two commissioners who respectively chair the commission’s financial oversight and evaluation committees. The Commission also will hear from the deputy director of the Department of Health Care Services’ mental health and substance use disorder services division, who will discuss the department’s new role in providing oversight of MHSA funds and the impact of the MHSA on statewide capacity to provide mental health services and supports. Finally, representatives from Los Angeles and Sonoma county behavioral health departments will discuss how the MHSA funds have been used in their counties and describe their efforts to measure, track and evaluate MHSA outcomes.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Conference Room 175 on the first floor of 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Tuesday, September 16, 2014.

PUBLIC NOTICE

On Tuesday, September 23, 2014, the Little Hoover Commission will conduct a public hearing on Proposition 63, the Mental Health Services Act of 2004. The hearing will begin at 9:30 a.m. in Room 437 of the State Capitol in Sacramento.

At this hearing, the Commission will review oversight mechanisms for the Mental Health Services Act (MHSA) funding and the outcomes resulting from the state’s investment of this funding in mental health services.

The Commission will first hear from a co-author of the initiative who will provide his 2004 and current expectations for the initiative, explain how the Act has changed and consider the appropriateness of the current oversight structure. Next, a panel comprised of two organizations that represent clients and their families has been asked to discuss how mental health services have fared since passage of MHSA. The Commission will then hear from the director of research and evaluation of the Mental Health Services Oversight and Accountability Commission, who will discuss the commission’s evolving role and strategies to improve oversight of the MHSA funds. The director will be accompanied by two commissioners who respectively chair the commission’s financial oversight and evaluation committees. The Commission also will hear from the deputy director of the Department of Health Care Services’ mental health and substance use disorder services division, who will discuss the department’s new role in providing oversight of MHSA funds and the impact of the MHSA on statewide capacity to provide mental health services and supports. Finally, representatives from Los Angeles and Sonoma county behavioral health departments will discuss how the MHSA funds have been used in their counties and describe their efforts to measure, track and evaluate MHSA outcomes.

There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. Immediately following the hearing, the Commission will hold a business meeting in Conference Room 175 on the first floor of 925 L Street in Sacramento.

All public notices for meetings are on the Commission’s website, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Commission Executive Director Carole D’Elia at (916) 445-2125 or littlehoover@lhc.ca.gov by Tuesday, September 16, 2014.